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Refill Request Form
The refill request
form requires that personal health information be
transmitted via the internet. We have undertaken
appropriate measures to ensure the confidentiality of
this information (secure internet connection, restricted
access to information provided). However, whenever the
internet is used to transmit personal health
information, there is a risk that this information may
not remain confidential.
By using the online
refill request form, you agree that you have read the
above, understand the risk, and agree to proceed.
This page is not
currently functioning due to change in internet hosting.
We hope to have this return soon.
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